Plasma and adipose tissue fatty acids of diabetic children on long-term corn oil diets.

A method is described to determine the fatty acid composition of small samples of subcutaneous adipose tissue, and of fasting plasma free fatty acids (FFA) and triglycerides. These analyses were carried out on samples from five normal children, six diabetic children consuming a standard diabetic diet, 17 diabetic children prescribed a diet rich in corn oil since diagnosis 4-7 years ago, and 2 brothers with familial hypercholesterolemia on a corn oil diet for 3 yr. The results obtained showed that: (1) The composition of adipose tissue triglycerides in the diabetic children on a standard diet was similar to that in the normal children. (2) The 17 diabetic children were consuming different quantities of corn oil. (3) There was a highly significant correlation between the percentage of linoleic acid present in adipose tissue and in the fasting plasma FFA fraction. It is therefore concluded that future assessments of the adherence of these diabetic children to their corn oil diet will be possible by examination of the fasting plasma FFA fraction, obviating the need for repeated adipose tissue biopsies. (4) The sum of the concentration of saturated and monounsaturated fatty acids of the same chain length in adipose tissue was similar to that in the fasting plasma FFA fraction, even though the proportions of individual acids were different in the two fractions.

An outbreak of Clostridium difficile necrotizing enterocolitis: a case for oral vancomycin therapy?

During a 2-month period, 13 infants in this neonatal intensive care unit developed necrotizing enterocolitis, increasing the prevalence in inborns from 5.2 to 20.5/1,000 live births. Fifty-seven perinatal and neonatal factors, many of which have previously been associated with necrotizing enterocolitis, were compared between the infants with necrotizing enterocolitis and 17 unaffected inborn control infants admitted concurrently. Clostridium difficile cytotoxin was detected in the stools of 12 affected infants (92.3%) in comparison with two control infants (11.8%) (P less than .001), and the organism was isolated in eight affected neonates (61.5%) compared to none of the control infants (P less than .001). The outbreak was terminated upon institution of oral vancomycin therapy in cases and infant contacts, and strict antiinfective measures in the neonatal intensive care unit. This indicates an etiologic role of C difficile in the outbreak. Oral vancomycin in the management of necrotizing enterocolitis was assessed by therapeutic response, drug levels, and occurrence of side effects. Oral vancomycin therapy is indicated in necrotizing enterocolitis outbreaks in units where C difficile is endemic.

Placental weight in diabetic pregnancies.

The placenta from 30 women with diabetes mellitus were examined and weighed at delivery. Nineteen of these were from women with overt and eleven from women with gestational diabetes. Eleven placentae from normal pregnancies served as controls. There was no difference between the mean +/- s.d. placental weight for the diabetic group and the control group (609 +/- 148 versus 591 +/- 93 g, NS). The mean placental weight ratios for the diabetic group and the control group were also similar (0.98 +/- 0.23 versus 0.89 +/- 0.15, NS). Moreover, there was no difference between the weights and weight ratios of placentae from women with overt (622 +/- 173 g, 1.02 +/- 0.27) and those with gestational diabetes (586 +/- 90 g, versus 0.90 +/- 0.13). Placental weights correlated with birthweights (r = 0.70, P less than 0.01) and with skinfold thickness measurements fo the infants (r = 0.40, P less than 0.05), but neither with gestational ages (r = 0.15, NS) nor with maternal glycosylated haemoglobin levels in the third trimester (r = 0.24, NS). Among the women with overt diabetes, placental weights were greater in those in White's class B and C than those in class D and R (689 +/- 143 versus 530 +/- 177 g; P less than 0.05). In general, placentae from well controlled diabetic patients were not heavier than those from normal pregnant women, although there was an increase in placental weight in White's class B and C, as compared with those in class D and R.

Postnatal changes in serum retinol status in very low birth weight infants.

BACKGROUND: Retinol deficiency may contribute toward the development of chronic lung disease in very low birth weight (VLBW) infants. We examined the retinol status during early infancy in VLBW infants from birth to 6 weeks 'post-term'. METHODS: Concentrations of serum retinol (SR) and its carrier proteins, retinol-binding protein (RBP), and transthyretin (TTR), were determined at birth, then weekly for 8 weeks, and at 4-6 weeks 'post-term' in preterm infants of less than 34 weeks gestation. The SR values of umbilical cord blood at birth from the preterm infants were compared to the maternal SR levels as well as to cord SR levels of term infants. RESULTS: From 24 through 33 weeks gestation, umbilical cord SR at birth was significantly lower than, but did not correlate with, maternal SR (P < 0.01). The cord SR in term infants was also higher than that in preterm infants (262 +/- 68 vs. 183 +/- 67 micrograms/l, P < 0.01). Longitudinal profiles of SR in 18 VLBW infants showed that, despite regular retinol supplementation, there was a decline in SR after birth, reaching a nadir of 128 +/- 40 microgram/l at 5-7 weeks (P < 0.001), followed by an increase toward levels comparable to those seen in full term infants. At follow-up at the corrected age of 4-6 weeks 'post-term', SR levels in VLBW infant (222 +/- 74 micrograms/l) had returned to within the normal range for term cord SR values. The concentrations of RBP also showed a similar biphasic pattern. Transthyretin levels did not change for 8 weeks but increased significantly at 4-6 weeks 'post-term'. CONCLUSIONS: Current practices of retinol supplementation in VLBW infants fail to maintain adequate retinol status in those infants during the neonatal period. Further efforts to improve the retinol status in these infants should be explored.

Intrauterine fatty acid accretion rates in human brain: implications for fatty acid requirements.

Fatty acid components of infant brain were determined to assess fatty acid requirements for synthesis of structural lipids in brain tissue during the last trimester of development in the fetus. Quantitative fatty acid analysis of cerebellum, frontal and occipital brain lobes indicated rapid accretion of chain elongation and desaturation products during the last trimester of brain growth. Frontal and occipital brain lobes were similar in fatty acid content. Fatty acid accretion rates were determined by regression analysis of tissue fat components at varying gestational ages. Tissue accretion of saturated and omega-9 fatty acids, as well as total fatty acid content, paralleled increases in whole brain weight. Levels of linoleic (C18:2, omega-6) and linolenic (C18:3, omega-3) acids were consistently low in brain during the last trimester of development, while marked substantial accretion of long chain desaturation products, arachidonic (C20:4, omega-6) and docosahexaenoic (C22:6, omega-3) acids occurred. Accretion of individual fatty acids of cerebellum also reflected changes in tissue total fatty acid content, with exception of the levels of C18:3, omega-3 and its chain elongation products present in cerebellum during the last trimester. These developmental changes and estimates of fatty acid incorporation into whole brain and cerebellum are quantitatively relevant to estimation of fatty acid requirements of the low birth weight neonate.

Extrauterine fatty acid accretion in infant brain: implications for fatty acid requirements.

Total fatty acid content of infant brain was determined to assess minimal fatty acid requirements for synthesis of structural lipids in brain tissue during the first 13 weeks of life. Fatty acid accretion rates were determined by regression analysis of tissue fat components at varying postnatal ages. Quantitative fatty acid analysis indicated that postnatal accretion of long-chain polyenoic fatty acids in cerebellum, frontal and occipital brain lobes initially appeared to lag behind the rate of increase in brain weight and brain fat content. After a 4-week period total long-chain fatty acids increased at a rate similar to the increase in brain weight. Accretion of individual fatty acids in cerebellum also reflected changes in tissue total fatty acid content. These developmental changes in fatty acid components of whole brain and cerebellum are quantitatively relevant to estimation of the minimal extrauterine fatty acid requirements of the human neonate.

Macro-mineral content of milk obtained during early lactation from mothers of premature infants.

Milk from mothers giving birth prematurely was analyzed for Na, Cl, K, Mg, Ca and P concentrations. The data presented are from analyses of milk samples representative of complete 24-hour expressions and collected serially over the first 29 days of lactation from mothers giving birth at term (FT) and mothers giving birth prematurely (PT). Mineral composition of FT and PT milks was similar during the first month lactation. With the exceptions of Mg and P, the concentrations of the minerals studied were higher initially than at the end of the fourth week of lactation. From these data, intakes of premature infants fed their own mothers' milk can be estimated and compared to predicted mineral requirements for the premature infant. On the basis of this comparison, we suggest that the quantities provided of Na, Cl, K and Mg, but not Ca and P, would be adequate to meet requirements of premature infants during the early weeks of life.

Fatty acid utilization in perinatal de novo synthesis of tissues.

The fatty acid content of fetal tissues was utilized to estimate essential fatty acid accretion during intrauterine growth. These rates of essential fatty acid accretion were used to predict that 400 mg/kg of body weight for omega-6 fatty acids and 50 mg/kg of body weight for omega-3 fatty acids per day would be used for intrauterine de novo synthesis of tissues. For the high risk low birth weight infant of approx. 1300 g birthweight it can be calculated that extrauterine de novo tissue synthesis would utilize about 280 mg/kg of body weight for omega-6 fatty acids and about 35 mg/kg of body weight for omega-3 fatty acids based on projected growth rates that are similar in composition to intrauterine growth and amount to 17 g of gain per day. From fatty acid analysis of brown and white adipose tissue it was estimated that some 70 and 78% of these net whole body accretion rates for essential fatty acids represent omega-6 and omega-3 fatty acid accretion in the adipose organs. Fatty acid analysis of human milk at day 16 of lactation was utilized to estimate the low birth weight infants' daily intake of major essential and other fatty acids. For intake levels of 120 kcal/kg it was concluded that the essential fatty acid content of mothers' own milk provides 6650 +/- 345 mg of total fatty acids, 850 +/- 160 mg of omega-6 fatty acids and 140 +/- 17 mg of omega-3 fatty acids.

Fatty acid accretion in the development of human spinal cord.

Lumbar and cervical segments of fetal and infant spinal cord were examined to determine the deposition rate of individual fatty acids in the spinal cord during the last trimester of fetal development and first 16 weeks of life. Fatty acid accretion rates were determined by regression analysis of spinal cord fatty acids at varying developmental ages. During the last trimester of fetal growth, accretion of major tissue fatty acids occurred earlier in cervical segments of spinal cord and at a greater rate than observed in lumbar regions. Postnatal accretion of fatty acids in cervical regions of spinal cord was minimal on a per gram of tissue basis with the exception of moderate increases in total omega-9 and saturated fatty acids, reflecting myelination. Significant postnatal accretion of fatty acids in lumbar regions of the spinal cord occurred some 4 weeks postnatally at rates significantly in excess of in utero rates. These developmental changes in fatty acid accretion are quantitatively relevant to estimates of fatty acid incorporation into spinal cord and parallel known processes of myelination and increasing neuro-motor activity in the developing infant.

Fatty acid accretion in fetal and neonatal liver: implications for fatty acid requirements.

The fatty acid content of liver was determined during the last trimester of infant growth and first 4 months of life in order to estimate fatty acid levels of developing liver and to assess minimal fatty acid requirements for tissue synthesis. Accretion rates were computed by regression analysis on fatty acid determinants of total liver lipid extracts from infants of varying developmental ages. During the last trimester of liver growth, accretion of most fatty acids paralleled increases in liver weight with the exception of C18:3, omega-3. This fatty acid remained at consistently low levels during the last trimester and represented less than 10% of total omega-3 fatty acids present in liver, even though significant accretion of longer chain omega-3 homologues occurred during the final trimester. For the term infants studied, significant increase in liver weight did not occur during the early weeks of life. However, liver levels of major fatty acids declined during the first five weeks of life apparently reflecting mobilization of saturated, omega-9 and omega-3 fatty acids from liver. During the first four months of life C18:2, omega-6 and total omega-6 fatty acid content of liver increased about 3.5- and 2-fold, respectively. After the initial 5 week lag net accretion of other fatty acid components also occurred in the developing liver. These developmental changes in fatty acid components of liver are quantitatively relevant to estimating the magnitude of the potential essential fatty acid reserve that may be present in liver of the developing human neonate.

'Normal' haemostasis parameters: a study in a well-defined inborn population of preterm infants.

Coagulation studies were performed in a well-defined inborn population of preterm neonates in cord blood and arterial blood obtained at age 48 h. Eighty infants fulfilled all the inclusion criteria. Our results show an increase in the hepatic vitamin K1 dependent and independent factors with postnatal age. The APTT became shorter, the factor II-VII-X, alpha 2-antiplasmin, plasminogen activities and fibrinogen level rose with increasing postnatal age. We found no change in the platelet parameters measured with postnatal age except that the megathrombocyte index was increased at age 48 h in infants less than 29 weeks gestation. There was little change with gestational age of any factors except the vitamin K1 dependent factors. Factor II-VII-X activity rose and the APTT became shorter with increasing gestational age. Many of the haemostasis results did not fall within the normal adult range. We discuss the significance of 'abnormal' and 'normal' results in preterm infants.

Randomized controlled trial of very early continuous distending pressure in the management of preterm infants.

Application of continuous distending pressure at birth (very early CDP) should stabilize the immature airways and reduce the severity of respiratory distress syndrome (RDS) in preterm infants. Eighty-two preterm infants of less than 32 weeks gestation were randomly assigned at birth to early treatment group (TG), in which CDP of 6 cm water pressure was applied at birth by the nasopharyngeal route (NP-CDP), or to control group (CG), in which CDP was applied when indicated for established criteria (pO2 less than 50 mmHg in FiO2 greater than 0.5). Characteristics of the infants in the two groups were comparable. No statistically significant difference between the two groups was found in the incidence of RDS. The course of RDS, and oxygen and ventilatory requirements also did not appear to be changed. In blood gas parameters of most of the time frames, no significant difference was found between the two groups when the results were analyzed according to the assigned group. When the results were analyzed separately for the infants who developed RDS, infants in TG appear to have fared worse from the therapy in terms of oxygenation, as indicated by significantly higher FiO2 (P less than 0.01) and lower a/A (P less than 0.01) values on the third day of the course of RDS, as compared to infants in CG. The incidence of complications was comparable in the two groups. Four infants from TG (9.3%) and one from CG (2.6%) died (P = NS). We conclude that VECDP by nasopharyngeal route does not reduce the incidence of RDS and does not appear to improve the outcome and may worsen the severity of RDS when compared to application of CDP for established criteria.

Free fatty acid content of human milk: physiologic significance and artifactual determinants.

Analysis of human milk was conducted to determine if free fatty acids occur naturally or as a consequence of artifactual lipolysis after milk expression. Five mothers provided triplicate early morning milk samples on day 43 of lactation. Following extraction, lipid classes were separated by preparative thin layer chromatography and quantified by capillary gas liquid chromatography. Fresh milk samples collected with 20 volumes chloroform-methanol (1:1, v/v) were analogous in total free fatty acid level and profile of fatty acids to a duplicate sample collected with 0.4M EDTA and immediately frozen at -10 C. Low milk levels of free fatty acids appear to exist naturally. During days 4-37 of lactation, four serial milk samples from 15 mothers were collected and frozen with 0.4M EDTA. The concentration of free fatty acids in colostrum (0.03-0.5%, w/w) was lower than for subsequent days (0.3-2.5%, w/w). Additional samples were collected with and without a lipase inhibitor (0.4M EDTA) and subjected to routine collection and storage procedures. Significantly different fatty acid profile and higher levels of free fatty acids in milk collected without a lipase inhibitor added indicate that domestic freezing and/or thawing ruptures the fat globule membrane, allowing sn-1-stereospecific serum stimulated lipoprotein lipase contact with its triglyceride substrate. Standard procedures for collection of human milk for gavage fed infants appears to stimulate artifactual lipolysis of milk triglyceride and subsequent release of free fatty acids. The proposed relationship between dietary free fatty acids and prolonged, unconjugated hyperbilirubinemia in the newborn is discussed with regard to the significance of preintestinal lipolysis.

Predictors of one-year developmental status in low birth weight infants.

The purpose of the present study was to describe the relations among various perinatal, environmental, and demographic measures in a sample of low birth weight infants and to relate those measures to 1-year developmental status. Perinatal variables included birth weight, gestational age, Apgar scores, and summary measures of respiratory distress and morbidity. Home visits provided ratings of the infants' environment at 7 and 12 months corrected age. The Bayley Scales of Infant Development were given at the 12-month home visit. A principal components factor analysis revealed four factors. The first factor was labeled an immaturity-illness factor, since it was primarily composed of gestational age, birth weight, and the respiratory distress and morbidity summary scores. Ratings of the infant's home environment loaded on the second factor, the demographic variables on the third factor, and the 1- and 5-minute Apgar scores comprised the fourth factor. The four factor scores together with the number of delays on the Denver Developmental Screening Test, given at 7 months corrected age, were entered as independent variables in four multiple regression analyses with the corrected and uncorrected mental development index index (MDI) and psychomotor development index (PDI) Bayley scores as the dependent variables. These regression analyses indicated that 1-year developmental status is a reflection of the infant's immaturity and neonatal morbidity, the quality of his or her home environment, and freedom from sensorimotor delays.

Renal handling of phosphate in very low birthweight (VLBW) infants (less than 1.3 kg): effects of calcium and sodium intake.

Five patient groups of VLBW infants with the same P-intake but varying Ca and Na intake were examined as to their urinary excretion of P and Na and on their renal clearance of P. The effect of increasing the Na intake from 1.5 to 3 mEq/kg/24 h on C(P) was also examined. In the control group of infants with an intake of 210 mg Ca and 80 mg P/kg/24 h, the C(P) was significantly correlated with postnatal, but not postconceptional age. A relatively low Ca intake of 100 mg/kg/24 h led to age-related values two to three times as high, whereas Ca supplementation to a total intake of 250 mg/kg/24 h decreased the C(P) significantly. A Ca intake of 175 mg/kg/24 h led to C(P) similar to those seen with one of 100 mg/kg/24 h. Changing the Na intake from 1,5 to 3 mEq/kg/24 h did not influence the C(P). There was no correlation between UP and UNa in any of the patient groups examined.

Children are different: environmental contaminants and children's health.

Although the impact of environmental contaminants on human health has been widely studied, few reports in the Canadian literature have focussed on the specific vulnerability of children. Because of their rapid growth, physiologic and metabolic immaturity, the fetus and child are often at increased risk from toxic substances in their environments. Furthermore, greater air, food and fluid intakes relative to body weight compared with the adult, increase the child's potential for excessive exposures. The crawling stage of infancy, the play patterns and short stature of toddlers also serve to increase their exposure to dust and heavy and volatile substances which accumulate near the floor. This article provides an overview of some of the developmental physiologic, anatomic and behavioural features of the fetus, infant and child which increase their vulnerability to environmental contaminants in comparison with adults. Specific examples are given.